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1 ti <br /> W_ _7V <br /> CITY of ORONO <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> OF <br /> � On the North Shore of Lake Minnetonka <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Rights of subjectt or <br /> Of <br /> data", we would like to inform you that your request for a P require <br /> rono or any of its <br /> you to furnish certain pricense frm the City ofivate or confidential departments information.. <br /> You are ,notified that: <br /> 1. The information you furnish will be used to determine your <br /> qualification for the permit or license requested. <br /> 2. You may refuse to supply data, but refusal may require that <br /> the City deny the permit or license. <br /> 3. other <br /> al , state <br /> The information to the extenthared necessaryhto processcthe permit or <br /> federal agencies <br /> license. <br /> 4. If your requested permit or license requires Council action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review private <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> ' _ <br /> First Middle� Last <br /> Address <br /> City State Zip <br /> G-/ 7 <br /> Phone <br /> I understand my rights as sta d above. <br /> ignature <br /> BUILDING&ZONING-473-7357 • ADMINISTRATION&FINANCE-473-7358 <br /> • PUBLIC WORKS-473-7359 <br /> ASSESSING <br />